Treating Homeless Opioid Dependent Patients with Buprenorphine in an Office-Based Setting


Show simple item record Alford, Daniel P. en_US LaBelle, Colleen T. en_US Richardson, Jessica M. en_US O'Connell, James J. en_US Hohl, Carole A. en_US Cheng, Debbie M. en_US Samet, Jeffrey H. en_US 2012-01-09T20:58:06Z 2012-01-09T20:58:06Z 2007-1-17 en_US
dc.identifier.citation Alford, Daniel P., Colleen T. LaBelle, Jessica M. Richardson, James J. O'Connell, Carole A. Hohl, Debbie M. Cheng, Jeffrey H. Samet. "Treating Homeless Opioid Dependent Patients with Buprenorphine in an Office-Based Setting" Journal of General Internal Medicine 22(2): 171-176. (2007) en_US
dc.identifier.issn 1525-1497 en_US
dc.description.abstract CONTEXT Although office-based opioid treatment with buprenorphine (OBOT-B) has been successfully implemented in primary care settings in the US, its use has not been reported in homeless patients. OBJECTIVE To characterize the feasibility of OBOT-B in homeless relative to housed patients. DESIGN A retrospective record review examining treatment failure, drug use, utilization of substance abuse treatment services, and intensity of clinical support by a nurse care manager (NCM) among homeless and housed patients in an OBOT-B program between August 2003 and October 2004. Treatment failure was defined as elopement before completing medication induction, discharge after medication induction due to ongoing drug use with concurrent nonadherence with intensified treatment, or discharge due to disruptive behavior. RESULTS Of 44 homeless and 41 housed patients enrolled over 12 months, homeless patients were more likely to be older, nonwhite, unemployed, infected with HIV and hepatitis C, and report a psychiatric illness. Homeless patients had fewer social supports and more chronic substance abuse histories with a 3- to 6-fold greater number of years of drug use, number of detoxification attempts and percentage with a history of methadone maintenance treatment. The proportion of subjects with treatment failure for the homeless (21%) and housed (22%) did not differ (P=.94). At 12 months, both groups had similar proportions with illicit opioid use [Odds ratio (OR), 0.9 (95% CI, 0.5–1.7) P=.8], utilization of counseling (homeless, 46%; housed, 49%; P=.95), and participation in mutual-help groups (homeless, 25%; housed, 29%; P=.96). At 12 months, 36% of the homeless group was no longer homeless. During the first month of treatment, homeless patients required more clinical support from the NCM than housed patients. CONCLUSIONS Despite homeless opioid dependent patients' social instability, greater comorbidities, and more chronic drug use, office-based opioid treatment with buprenorphine was effectively implemented in this population comparable to outcomes in housed patients with respect to treatment failure, illicit opioid use, and utilization of substance abuse treatment. en_US
dc.language.iso en en_US
dc.publisher Springer-Verlag en_US
dc.rights Copyright Society of General Internal Medicine 2007 en_US
dc.subject Buprenorphine en_US
dc.subject Drug dependence en_US
dc.subject Primary care en_US
dc.subject Homelessness en_US
dc.title Treating Homeless Opioid Dependent Patients with Buprenorphine in an Office-Based Setting en_US
dc.type article en_US
dc.identifier.doi 10.1007/s11606-006-0023-1 en_US
dc.identifier.pubmedid 17356982 en_US
dc.identifier.pmcid 1824722 en_US

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